| Home > 106th Congressional Bills > S. 3132 (is) To expand the boundary of the George Washington Birthplace National Monument, and for other purposes. [Introduced in Senate] ...
S. 3132 (is) To expand the boundary of the George Washington Birthplace National Monument, and for other purposes. [Introduced in Senate] ...
106th CONGRESS 2d Session S. 3131 To amend title XVIII of the Social Security Act to ensure that the Secretary of Health and Human Services provides appropriate guidance to physicians and other health care providers that are attempting to properly submit claims under the Medicare Program and to ensure that the Secretary targets truly fraudulent activity for enforcement of Medicare billing regulations, rather than inadvertent billing errors. _______________________________________________________________________ IN THE SENATE OF THE UNITED STATES September 28 (legislative day, September 22), 2000 Mr. Murkowski (for himself and Mr. Abraham) introduced the following bill; which was read twice and referred to the Committee on Finance _______________________________________________________________________ A BILL To amend title XVIII of the Social Security Act to ensure that the Secretary of Health and Human Services provides appropriate guidance to physicians and other health care providers that are attempting to properly submit claims under the Medicare Program and to ensure that the Secretary targets truly fraudulent activity for enforcement of Medicare billing regulations, rather than inadvertant billing errors. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE; TABLE OF CONTENTS. (a) Short Title.--This Act may be cited as the ``Medicare Billing and Education Act of 2000''. (b) Table of Contents.--The table of contents of this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Findings. Sec. 3. Definitions. TITLE I--REGULATORY REFORM Sec. 101. Prospective application of certain regulations. Sec. 102. Requirements for judicial and regulatory challenges of regulations. Sec. 103. Prohibition of recovering past overpayments by certain means. Sec. 104. Prohibition of recovering past overpayments if appeal pending. TITLE II--APPEALS PROCESS REFORMS Sec. 201. Reform of post-payment audit process. Sec. 202. Definitions relating to protections for physicians, suppliers, and providers of services. Sec. 203. Right to appeal on behalf of deceased beneficiaries. TITLE III--EDUCATION COMPONENTS Sec. 301. Designated funding levels for provider education. Sec. 302. Advisory opinions. TITLE IV--SUSTAINABLE GROWTH RATE REFORMS Sec. 401. Inclusion of regulatory costs in the calculation of the sustainable growth rate. TITLE V--STUDIES AND REPORTS Sec. 501. GAO audit and report on compliance with certain statutory administrative procedure requirements. Sec. 502. GAO study and report on provider participation. Sec. 503. GAO audit of random sample audits. SEC. 2. FINDINGS. Congress finds the following: (1) Physicians, providers of services, and suppliers of medical equipment and supplies that participate in the Medicare Program under title XVIII of the Social Security Act must contend with over 100,000 pages of complex Medicare regulations, most of which are unknowable to the average health care provider. (2) Many physicians are choosing to discontinue participation in the Medicare Program to avoid becoming the target of an overzealous Government investigation regarding compliance with the extensive regulations governing the submission and payment of Medicare claims. (3) Health Care Financing Administration contractors send post-payment review letters to physicians that require the physician to submit to additional substantial Government interference with the practice of the physician in order to preserve the physician's right to due process. (4) When a Health Care Financing Administration contractor sends a post-payment review letter to a physician, that contractor often has no telephone or face-to-face communication with the physician, provider of services, or supplier. (5) The Health Care Financing Administration targets billing errors as though health care providers have committed fraudulent acts, but has not adequately educated physicians, providers of services, and suppliers regarding Medicare billing requirements. (6) The Office of the Inspector General of the Department of Health and Human Services found that 75 percent of surveyed physicians had never received any educational materials from a Health Care Financing Administration contractor concerning the equipment and supply ordering process. SEC. 3. DEFINITIONS. In this Act: (1) Applicable authority.--The term ``applicable authority'' has the meaning given such term in section 1861(uu)(1) of the Social Security Act (as added by section 202). (2) Carrier.--The term ``carrier'' means a carrier (as defined in section 1842(f) of the Social Security Act (42 U.S.C. 1395u(f))) with a contract under title XVIII of such Act to administer benefits under part B of such title. (3) Extrapolation.--The term ``extrapolation'' has the meaning given such term in section 1861(uu)(2) of the Social Security Act (as added by section 202). (4) Fiscal intermediary.--The term ``fiscal intermediary'' means a fiscal intermediary (as defined in section 1816(a) of the Social Security Act (42 U.S.C. 1395h(a))) with an agreement under section 1816 of such Act to administer benefits under part A or B of such title. (5) Health care provider.--The term ``health care provider'' has the meaning given the term ``eligible provider'' in section 1897(a)(2) of the Social Security Act (as added by section 301). (6) Medicare program.--The term ``Medicare Program'' means the health benefits program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.). (7) Prepayment review.--The term ``prepayment review'' has the meaning given such term in section 1861(uu)(3) of the Social Security Act (as added by section 202). (8) Secretary.--The term ``Secretary'' means the Secretary of Health and Human Services. TITLE I--REGULATORY REFORM SEC. 101. PROSPECTIVE APPLICATION OF CERTAIN REGULATIONS. Section 1871(a) of the Social Security Act (42 U.S.C. 1395hh(a)) is amended by adding at the end the following new paragraph: ``(3) Any regulation described under paragraph (2) may not take effect earlier than the date on which such regulation becomes a final regulation. Any regulation described under such paragraph that applies to an agency action, including any agency determination, shall only apply as that regulation is in effect at the time that agency action is taken.''. SEC. 102. REQUIREMENTS FOR JUDICIAL AND REGULATORY CHALLENGES OF REGULATIONS. (a) Right To Challenge Constitutionality and Statutory Authority of HCFA Regulations.--Section 1872 of the Social Security Act (42 U.S.C. 1395ii) is amended to read as follows: ``application of certain provisions of title ii ``Sec. 1872. The provisions of sections 206 and 216(j), and of subsections (a), (d), (e), (h), (i), (j), (k), and (l) of section 205, shall also apply with respect to this title to the same extent as they are applicable with respect to title II, except that-- ``(1) in applying such provisions with respect to this title, any reference therein to the Commissioner of Social Security or the Social Security Administration shall be considered a reference to the Secretary or the Department of Health and Human Services, respectively; and ``(2) section 205(h) shall not apply with respect to any action brought against the Secretary under section 1331 or 1346 of title 28, United States Code, regardless of whether such action is unrelated to a specific determination of the Secretary, that challenges-- ``(A) the constitutionality of substantive or interpretive rules of general applicability issued by the Secretary; ``(B) the Secretary's statutory authority to promulgate such substantive or interpretive rules of general applicability; or ``(C) a finding of good cause under subparagraph (B) of the sentence following section 553(b)(3) of title 5, United States Code, if used in the promulgation of substantive or interpretive rules of general applicability issued by the Secretary.''. (b) Construction of Hearing Rights Relating to Determinations by the Secretary Regarding Agreements With Providers of Services.--Section 1866(h) of the Social Security Act (42 U.S.C. 1395cc(h)) is amended by adding at the end the following new paragraph: ``(3) For purposes of applying paragraph (1), an institution or agency dissatisfied with a determination by the Secretary described in such paragraph shall be entitled to a hearing thereon regardless of whether-- ``(A) such determination has been made by the Secretary or by a State pursuant to an agreement entered into with the Secretary under section 1864; or ``(B) the Secretary has imposed or may impose a remedy, penalty, or other sanction on the institution or agency in connection with such determination.''. SEC. 103. PROHIBITION OF RECOVERING PAST OVERPAYMENTS BY CERTAIN MEANS. (a) In General.--Except as provided in subsection (b) and notwithstanding sections 1815(a), 1842(b), and 1861(v)(1)(A)(ii) of the Social Security Act (42 U.S.C. 1395g(a), 1395u(a), and 1395x(v)(1)(A)(ii)), or any other provision of law, for purposes of applying sections 1842(b)(3)(B)(ii), 1866(a)(1)(B)(ii), 1870, and 1893 of such Act (42 U.S.C. 1395u(b)(3)(B)(ii), 1395cc(a)(1)(B)(ii), 1395gg, and 1395ddd), the Secretary may not offset any future payment to a health care provider to recoup a previously made overpayment, but instead shall establish a repayment plan to recoup such an overpayment. (b) Exception.--This section shall not apply to cases in which the Secretary finds evidence of fraud or similar fault on the part of such provider. SEC. 104. PROHIBITION OF RECOVERING PAST OVERPAYMENTS IF APPEAL PENDING. (a) Notwithstanding any provision of law, for purposes of applying sections 1842(b)(3)(B)(ii), 1866(a)(1)(B)(ii), 1870, and 1893 of the Social Security Act (42 U.S.C. 1395u(b)(3)(B)(ii), 1395cc(a)(1)(B)(ii), 1395gg, and 1395ddd), the Secretary may not take any action (or authorize any other person, including any fiscal intermediary, carrier, and contractor under section 1893 of such Act (42 U.S.C. 1395ddd)) to recoup an overpayment during the period in which a health care provider is appealing a determination that such an overpayment has been made or the amount of the overpayment. (b) Exception.--This section shall not apply to cases in which the Secretary finds evidence of fraud or similar fault on the part of such provider. TITLE II--APPEALS PROCESS REFORMS SEC. 201. REFORM OF POST-PAYMENT AUDIT PROCESS. (a) Communications to Physicians.--Section 1842 of the Social Security Act (42 U.S.C. 1395u) is amended by adding at the end the following new subsection: ``(u)(1)(A) Except as provided in paragraph (2), in carrying out its contract under subsection (b)(3), with respect to physicians' services, the carrier shall provide for the recoupment of overpayments in the manner described in the succeeding subparagraphs if-- ``(i) the carrier or a contractor under section 1893 has not requested any relevant record or file; and ``(ii) the case has not been referred to the Department of Justice or the Office of Inspector General. ``(B)(i) During the 1-year period beginning on the date on which a physician receives an overpayment, the physician may return the overpayment to the carrier making such overpayment without any penalty. ``(ii) If a physician returns an overpayment under clause (i), neither the carrier nor the contractor under section 1893 may begin an investigation or target such physician based on any claim associated with the amount the physician has repaid. ``(C) The carrier or a contractor under section 1893 may not recoup or offset payment amounts based on extrapolation (as defined in section 1861(uu)(2)) if the physician has not been the subject of a post- payment audit. ``(D) As part of any written consent settlement communication, the carrier or a contractor under section 1893 shall clearly state that the physician may submit additional information (including evidence other than medical records) to dispute the overpayment amount without waiving any administrative remedy or right to appeal the amount of the overpayment. ``(E) As part of the administrative appeals process for any amount in controversy, a physician may directly appeal any adverse determination of the carrier or a contractor under section 1893 to an administrative law judge. ``(F)(i) Each consent settlement communication from the carrier or a contractor under section 1893 shall clearly state that prepayment review (as defined in section 1861(uu)(3)) may be imposed where the physician submits an actual or projected repayment to the carrier or a contractor under section 1893. Any prepayment review shall cease if the physician demonstrates to the carrier that the physician has properly submitted clean claims (as defined in section 1816(c)(2)(B)(i)). ``(ii) Prepayment review may not be applied as a result of an action under section 201(a), 301(b), or 302. ``(2) If a carrier or a contractor under section 1893 identifies (before or during post-payment review activities) that a physician has submitted a claim with a coding, documentation, or billing inconsistency, before sending any written communication to such physician, the carrier or a contractor under section 1893 shall contact the physician by telephone or in person at the physician's place of business during regular business hours and shall-- ``(i) identify the billing anomaly; ``(ii) inform the physician of how to address the anomaly; and ``(iii) describe the type of coding or documentation that is required for the claim.''.
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